Malaria – What you need to know | African Overland Tours
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Malaria – What you need to know!

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Pharmacist

Obviously we are not health specialists, and will recommend you see a doctor or pharmacist for professional health advice with regards to malaria protection. This article must be treated as a guideline only.

Malaria is transmitted from person to person through the bite of a female Anopheles; a species of mosquito prevalent throughout sub-Saharan Africa and considered to be the most dangerous.

Only a small proportion of malaria infections are fatal, but children under five and pregnant women are particularly vulnerable due to their weaker immune systems. Malaria experts estimate that 1 to 2 percent of cases lead to fatalities.

But the figures are still astounding if you consider this:

Malaria kills over one million people each year. Each year there are over 300 million clinical cases of malaria, that is five times as many as combined cases of TB, AIDS, measles and leprosy. Malaria is responsible for one out of every four childhood deaths in Africa.

The high overall number of deaths from malaria reflects the regularity with which Africans, particularly the poorest segments of society, contract malaria. While the majority of healthy adults (who might be bitten up to twice a day by malarial mosquitos in the rainy season) withstand the malaria parasite, many children are hospitalised.

Distribution:

Accurately identifying malaria transmission areas is difficult. Within countries and even within regions in those countries, there are often malaria risk areas and other areas that may be free from malaria. Malaria risk areas are not static and may change with time, depending on factors such as rainfall and migration of infected individuals.

The below map is fairly accurate though.

Malaria-distribution-in-Africa

Malaria distribution in Africa

Transmission also depends on the time of year, as many areas have seasonal malaria (including South Africa).

The most reliable way of preventing malaria is to avoid mosquito bites. It is more important than using preventive drugs. Malaria carrying mosquitoes feed between dusk and dawn both indoors and outdoors.

The following is advised:

Remain indoors between dusk and dawn if possible, otherwise cover up.

Wear long sleeved clothing (preferably light coloured), long trousers and socks.

Apply insect repellent to exposed skin, repeat as recommended on the container label. Avoid eyelids, lips, sun burnt or damaged skin, do not spray on the face and do not overdose young children.

Cover / close doorways and windows with screens, and the same goes for your tent, keep the netting over the door and windows.

Ceiling fans and air conditioners are very effective.

Use a mosquito-proof bed net over the bed, with edges tucked in under the mattress. Ensure that the net is not torn and that there are no mosquitoes inside. Essentially your tent can act as a big mosquito net, but then you must keep the tent flaps closed.

You can spray inside the house / tent with an aerosol insecticide  (for flying insects) at dusk or burn mosquito coils if you are not 100% sure that you effectively kept them out.

Is prophylaxis necessary?

If an individual is travelling to a malaria area, it is important to determine whether he / she requires prophylaxis, or whether adequate protection can be provided by the regular use of personal protection measures as discussed above.

The decision as to whether prophylaxis is necessary is subjective. It depends on the areas to be visited and the risk that the traveller has of being exposed to mosquitoes and of developing malaria. The greater the traveller’s risk of contracting malaria and developing complications, the more likely it will be that prophylaxis will be necessary.

One of the following 3 regimes is currently recommended for use in South Africa

Mefloquine (weekly).  Start at least one week before entering a malaria area.
Doxycycline (daily).  Start one day before entering a malaria area.
Chloroquine (weekly) PLUS proguanil (daily).  Start at least one day before entering a malaria area, but preferably a week before.

These regimes must be taken for FOUR weeks after leaving the malaria area.

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